Table 4 : Facilitators Identified.

Themes Responses

1) The Importance of Support and Support Networks
  • “Using promotoras helps to promote trust. That is something that we continue to do and it seems like people responds to that.”
  • “After bringing in young Hispanic college students to interact with our teens, we had one of the highest retention rates (in our clinical trial).”
  • “The promotora model helped us to provide education and seemed to work very well.”

2) Promoting Trust Between HCPs, Daughters, and Families
  • “I think that trust and listening to not just the diabetes, but everything that goes with their social issues (is important).”
  • “I feel trust is very important.”

3) Assessing Emotional Development
  • “Every child is different. Sometimes, (medical) residents will come back from an assessment and say, ‘You know, I don’t know that I feel that comfortable talking about sex with this child because they seem so young,’.  I think that, at times, there’s the aspect of ‘Okay, so they may seem young, but they’ll still have questions,’ and the added aspect of ‘Maybe they seem young and really are too young to absorb this information.’”
  • “As my patients have gotten much older, they always tease me because they tell me everything I did (discussing sex and RH) was—even though I thought it was early, it was late.”
  • “Recognizing teens’ autonomy and that they are trying to gain that independence and their role in addressing their own health and health behavior… was probably the greatest factor supporting their follow-up.”

4) Empowerment
  • (On making decisions that support a healthy pregnancy) “I think it’s very important that they feel empowered and making them feel that they have the power to decide these things and learn more.”
  • “The concept of really, really empowering these girls, and you do a great job on what you have and when you say, ‘You can do it when the time is right. You can have a healthy pregnancy,’ and then somewhere else you say, ‘Choice, you have the power to choose.’”

5) Safety
  • “Allow them to be safe with their diabetes and to think about the future so that it may motivate them.”
  • “When they get older—close to 17 or 18—I start talking about the importance of being safe during pregnancy, having the target range of blood sugars, and knowing where you are in your diabetes management.”

6) Communicating in Patients’ Preferred Language
  • “Sometimes, splitting and speaking in English to the adolescent and Spanish to the parent has been really helpful in facilitating the interrelationship with us as a team with the parent and the child.”
  • “If you speak the same language, adherence is better.”                       
  • “Address the child in the language they want to speak.”

7) Discussing RH-Related Topics and PC Using Cultural Sensitivity
  • “Mention marriage. Find some way to work the story around marriage and sex and reproducing as part of a package.”
  • “I wouldn’t presume to speak on what the role of religion or their faith position is, but ask them if it is important enough to mention.”
  • “It’s okay to talk about morals.”

8) Importance Being Ready/Temporality/Planning for the Future
  • “I say that we are giving this to you in preparation for the future.  It makes is easier for families to accept the information versus it being something like, ‘No, this doesn’t apply to her, because she’s not having sex.’”
  • (On framing RH-related conversations): “We frame the message as one thing that could be helpful, because we want to get to an individual as early as we can so that they can get information that can benefit them in the future; then, the parents look at this not as if you are labeling their children who have increased sexual activity but that you want to prevent challenges with pregnancy and childbirth as early as possible. This is designed to generate knowledge versus feeling like they are being targeted.”

9)Importance of Family-Centered Care
  • “The more you involve the extended family, the better.”
  • “With some of our patients, the grandparents are actually the ones making all the decisions. The parents are there and involved in the discussion, but the final decision will come from the grandparents.”
  •  “The girls come with mom and then they (the wife and daughter) have to talk to the dad before making decisions.”
  • “Dads want to know what is going on but always don’t want to know more. They can feel uncomfortable.”
  • “I have seen that often the mom has to go and talk to the dad. He’s like the main presence, even if he is not there (in the clinic). So, make them (the Latina adolescents) feel that they have the power to decide these things and learn more.”

10) Variation in Educational Tailoring and Dissemination/ Care Delivery
  • “I would break down (RH information and PC) into different sections over a year, but those with different education may have a little trouble with it.”
  • “Some of my first-generation patients would say, ‘There is a picture of a uterus…gets it out of my face!’”
  • “In our endocrine clinic, we deal with puberty, breasts, gonads, penises, and we have pictures on our wall. Those pictures are now covered in dresses because part of our Hispanic population was very much offended by those pictures and complained to administration.”
  • “I would point out the difference between the first generation coming from Managua or Mexico City, and first generation coming from really rural areas.”

Charron-Prochownik et al.Research Journal of Women's Health  2018 5:2DOI : 10.7243/2054-9865-5-2